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VIP notes from Dr. Becker's Big Bus Tour
Veterinarians should be the first place clients go for advice on wellness and diagnosis and treatment of disease. Yet there are so many new sources for information. How can we maintain our role as the cornerstone, the touchstone, of the relationship between pets and people?
How can I help YOU make sure you are doing the work you were meant to do on this earth? I've come up with a bunch of C's that form the cornerstone of veterinary practices that will be winners in the battle of vets vs. the Net. The more veterinarians we can enlist in the fight, the better. Indulge me the kind of metaphors I love here, because good metaphors stick to your ribs: We are, I'm afraid, heading into rough seas. And now is the time to make our ships C-worthy.
Here are the C's I want you to take with you today: Compassion, clarity, connection, communication, competence, and the courage to compete. Oh, and luminosity. Right, that's an L. But, it's an important L.
Compassion I think is probably the most important C. We are the clear winners here. The Internet cannot express compassion – at least not the way we can. The Internet cannot express compassion the way a live, engaged, genuinely empathetic veterinarian can. The Internet cannot express compassion the way a veterinarian who loves animals and loves people and is dedicated to protecting this all important Bond between them, can.
The Internet cannot reach out and touch the shoulder of a man or a woman – or a child – who thinks a lifelong companion could die. The Internet cannot find the comforting words necessary to help this human through this moment of pain, or offer a smile and say, “It's ok, there are things we can do…everything's going to be alright.”
In the practice at Sandpoint, Idaho, I met a lab/shepherd mix named Barney. He was my first visit of the day and his owner seemed delighted when I made his tail thump against the chair. Barney was in for vaccinations and to have a reoccurring ear problem checked. But as I listened I discovered the ear problem wasn't the real problem with Barney.
Barney was in trouble. Deep trouble. And, of course, he didn't know it. Or, if he knew it, he couldn't tell me about it.
I sensed trouble. It was something in the frustration in her voice when she talked about Barney's “bad-bug laboratory” – his ears. Just before I started the physical exam I turned to her. I said, “I sense you're having other problems with Barney you haven't told me about.” That's when the dam broke and the story came pouring out. She had started working again and Barney had started tearing the house apart. Her husband called it the “Unwanted Extreme Home Makeover.” And he wasn't really joking. He had told her if Barney didn't straighten up, they were going to have to get rid of him.
Now, I – of course – refrained from the marital counseling I was tempted to dispense then and there. She seemed to have a handle on that part of it. “I've had Barney longer than I've had my husband,” she said. However, it was easy to see she was scared.
Now, what I did next, the Internet can never ever do. I put one hand on Barney's head and the other on her arm. “This is a common problem,” I said with a smile.” I've helped dozens of other families who have a pet with separation anxiety and we'll get this fixed. You won't have to get rid of Barney… or your husband.”
I put Barney on the path of medication and behavior modification, both parts of a powerful, state-of-the-art and state-of-the-heart treatment plan in modern veterinary medicine. We certainly saved Barney, and we maybe saved a marriage. But even more than that, we kept veterinary medicine relevant for this woman and, no doubt, for every person she talks to. We had the power to do this. We did it through passion and com-passion… and we kicked the Internet's butt in the process.
When a loved one dies, would you not trade a thousand Facebook condolences for one good buddy who put his hand on your shoulder, looked you in the eyes and said, “I'll be there for you. Whatever you need. Let me know.” Wouldn't you trade for that?
The Internet cannot look a person in the eye and tell them with a smile and without words, that it is ok to love an animal this much.
The second C I've been thinking about is clarity. Brian Tracy says 80% of success comes from being clear on who you are, what you believe in, and what you want. Clarity helps clarify a lot of the issues veterinarians face in this battle for relevance. Most of all, I think, we have to be clear about ourselves. You have to be clear about who you are, what you believe and what you want.
Author Stephen Covey in the “7 Habits of Highly Effective People” talks about “Beginning with the end in mind.” Too many times we lose track of the end because we're too busy hacking through the hectic underbrush of daily practice just trying to move forward. But are we moving in the right direction? That's why a meeting like this is so important. We can shinny up the tallest tree, offering an extended hand if needed, to get to the top and look out into the distance to make sure the daily hacking is headed in the right direction.
For example, every single day in my prayers and in my thoughts I say this mantra that is as clear as glacial melt; Let my actions today positively promote the best interests of 3 Ps: Pets, People, my Profession. Then when I practice clarity gives me 20/10 vision to always put out front of my practice windshield the following goal: Make Every Client #1.
All of this doesn't matter if you don't do the third C, which is to connect. And to get new clients the days of a big ad in the local Yellow Pages is over. You need a robust, full-service Web presence. Borrowing the phrase from a successful ad campaign, “Humans when you want them, technology when you don't.”
Once people pull into your parking lot, you have to connect with them and the animals who pass through your practice. In fact, they have to not “pass through” your practice, they have to BE your practice. Think of it this way: They are LIVE in your practice. Your practice is not pre-recorded. And your practice day should not be pre-recorded either. The on-air sign should always be lit.
This means you have to connect, in a way the Internet cannot, with every client every time. You have to treat every client as if this is the only client you will see today. Before you open that exam room door, you have to fix this idea in your mind.
We hear a lot about multi-tasking today. We experience a lot of multi-tasking today, from the grocery sacker who is answering text messages between the frozen foods and the vegetables on the conveyer belt to the mechanic who is listening to his IPod while he tunes your engine , to the hotel clerk whose Web surfing we seem to have interrupted with our arrival. Our clients, remember, experience multi-tasking everywhere they go, just as we do.
Despite the research that shows multi-tasking doesn't also mean doing everything well at once, multi-tasking has become a way of life. But it cannot be our way of life.
I found out I could not be happy and fulfilled just talking about veterinary medicine, no matter how much good I thought carrying this message to the public on Good Morning America or Dr. Oz was doing for the profession. I realized I also had to do veterinary medicine, so I went back to practicing at the Lakewood Animal Hospital in Coeur d'Alene, Idaho and North Idaho Animal Hospital in Sandpoint, Idaho, as often as my schedule allows. I had to put my veterinary uniform --- the hybrid Canadian tuxedo denim shirt with red tie under a blue smock – I had to put it back on, drape the stethoscope around my neck, take in torrents of CE and get my hands dirty again in both the cathedral of the exam room and the guts of the practice.
In the same way, you can't beat the Internet by talking about your practice… with colleagues, consultants or whatever family members will still listen, or by talking about how wonderful your practice is on your home page or your Twitter account. You have to DO veterinary medicine in the exam room and to DO veterinary medicine, you have to connect with both the client and the pet as directly as a land-line telephone. No static. No dropped calls. You and the client alone and connected as your skilled hands, eyes, nose and ears conduct the tip-of-the-nose to tip-of-the-tail 3-D exam explaining every detail as those experienced and highly trained senses and mind do their magic.
While we're going to be connected heart-to-heart in the exam room, we're also going to embrace the newer forms of connection that can be embraced. As I said before, I've never had a single client I've asked not want to have their pet featured on our Facebook page. These pet moms and dads love to experience the outreach and feel the outpouring of genuine care and concern that is directed by fellow pet loving fans their way.
I'm not suggesting that social media can take the place of the kind of connection that happens only when you're interacting live, one-on-one, fully synced. Nor would I want you to email test results or answers to questions a client has about the case just to save time if the client prefers a call (unless of course they've indicated they would prefer email). Don't become so obsessed with high-tech that you lay the more important low-tech connections on the altar of efficiency.
When I'm in the exam room I want the dance to be intimate and slow, never rushed. Rather than have the exam table between us as a barrier, I scoot around the table close to the client where I can start to create a halo of connection. I show expressions of connection--- smile, eyebrow flash, nodding--- and season our time together with expressions of praise or empathy. Then, if the time is appropriate and possible, I ask if I can have the technician take a photo of us together and post if on Facebook so that people can follow and share in the experience.
I remember when I was a kid in Southern Idaho that children were not allowed in human hospitals and even adults were limited to very strict visitation hours. That loss of connection was detrimental to healing. What social media does is allows a huge extended network to be privy and partner to all that is going on with a patient and thus be there for both the pet and the person. The successful practice of the future will be one making the most of the big impact of being “real and synced up in real time” to the sustained ripples of social media.
Communication is the next Big C. Start by talking in terms clients understand. Most don't know –itis from –osis, -ectomy from –otomy, even benign from malignant. Dumb it down in order to have an intelligent conversation that can be repeated lucidly at home. And don't forget to stir the emotions before you stir the intellect. Start with the heart then move to the head. If you first give expressions of empathy and genuine concern, a client is much more likely to accept your professional recommendations and have more satisfaction and find more value in the visit.
We've talked a lot about communication in veterinary practice. But I want to dwell on one overlooked aspect of communication with you today. In this fight, we've got to provide a kind of communication that touches people, that touches people where they live. One of the things we can do – and this is something we don't do enough – is take some of the worry from them. Remember that song by Bill Withers “Lean on me?”
In a sense, we're designed to make people worry. We're trained to spot what's wrong. We're hard-wired for spotting what's wrong from our first years in veterinary school. We're like the English teacher who spots all the dangling participles and misplaced commas, but fails to recognize a brilliant phrase you created in the essay.
So, what we need to begin doing is looking for what's right with these pets, as well as what's wrong. We need to say, “Now, this is something we really have to worry about… this is serious.” But, we also have to train ourselves to say, “You're doing a great job on this. And this.” Put another way, give clients positive reinforcement for what's going right rather than focusing only on what's wrong. Catch clients doing the right behaviors and habits with their pets so that you have things in the emotional bank account to address the issues that need to be addressed.
For example, if a dog has two ears that are as hot as torches and need diagnostics to get to the root cause, you might say, “I notice his teeth and gums are very healthy. I don't know what you're doing to achieve this but I want to commend you for it and tell you that by having good oral health, your dog could live up to 15% longer…or an average of two years.” Here's another example, “The excessive drinking and urination almost certainly indicates a serious metabolic problem, but before we get down to the details of trying to figure out this puzzle I want to complement you on how well groomed and behaved “Nobody” is. He's lucky to have a mom like you who cares so much.”
If we are going to win this battle, we have to communicate the incredible understanding we have of the animal body, from the specifics to the abstract, from how the heart works to how the male cat's penis must have been designed by the summer intern. We have to educate. And, we must be the very best source of information for our clients – better than any source they can find through Google. Just like people will look at WebMD before they go to their doctor, we don't mind them going to trusted sites (that we recommend on our own Web sites) before they come in but it's not in place of coming in.
So, competence is another C we sometimes take for granted and in the intellectual marketplace of the Internet age, we don't dare. Competence isn't something that can be faked. It comes from years of working in the trenches of practice and from being on the bleeding-edge of veterinary CE. Competent practitioners learn something new every day.
I know one veterinarian who follows a Wikipedia piece through every link three days a week. They are confident but also second guess themselves by bringing other team members into the case, reaching out to colleagues in the practice across town or across the country via resources like VIN. Recognizing that you can't be the best at everything, you find areas of special interest or expertise - say stem cells or laser therapy for example - and leave the surgeries to a veterinarian for whom a comminuted, compound fracture comes together like tying shoelaces.
In that regard, we also have to be careful that we choose the right professionals to refer our grieving clients to. I spoke recently at the International Cemetery, Cremation and Funeral Association conference in Las Vegas, and watching some of the other presentations, I became aware of the huge pitfall of not choosing the right cremation or memorial service for those in our practice who are grieving. Some of what I could tell you is truly horrific.
We need to make sure we are not connected with some of these practices by making sure we are referring our clients to reputable people in the death care profession. What should we look for? Coleen Ellis tells me we want to make sure the service we choose has an open-door policy. We want to be sure we, our staff members or the family members have access to the facility during working hours. We want to make sure every part of the process is done with dignity. We need to be sure the service provides full disclosure, proper paperwork and private, one at a time, cremation. In addition to transparency, we want to know the service has a specialist to support a grieving client and if the client desires, can conduct a memorial service.
“You would choose a board certified surgeon to refer a pet to,” she says, “so why should this be different. You want to give them options other than walking out of the practice with a leash and a collar in their hands.” A good death to bookend a good life.
The physical examination, however, is your territory and in the cathedral of the exam room you are the expert. Every case deserves and demands a complete nonjudgmental workup and that includes medical, behavioral and an analysis of the current state of the Bond. Behavior can't be an adjunct to medicine; rather it needs to be a powerful allied program fully integrated into the daily fabric of veterinary practice. Barney's case is an example of the life saving power of fully integrating behavior into your toolbox.
Finally, the most important C on this list is to compete. We must have the courage to compete. We can't sit back and hang our heads and expect to thrive. It's time to claim our territory and our territory is the health and well-being of people and their pets, our territory is advocacy – for animals, for people and for the Bond between them. Advocacy means standing up for something.
Let me give you an example. You can be accused of being late for an appointment, missing a diagnosis or even charging too much…but the one thing you can't be accused of is not looking out for the pet's best interests. Every single animal that crosses your practice threshold deserves a thorough, non-judgmental approach. What products and services would you recommend if they were all free? What you recommend for a fee should be no different. Only the owner can decrease the recommended level of care. Not you. Never.
We're up against several severe threats in this new normal. You cannot put your head in the sand and deny the immutable change in people this recession has wrought. We've gone from the Me Decade to the Value Decade in a very short time and we are going to BE in the value decade a very long time. So, we're back where we were 30 years ago, trying to figure out what value we are giving – what value we can give that nobody else, and nothing else, can.
Start with this: To compete we've got to dedicate ourselves to creating a feeling of joy in our practices. Everything important can't be counted. Everything important doesn't show up in average client transaction figures. It can't always be measured on the bottom line. We will compete when people feel the joy we feel inside the guts of our practices, inside the cathedral of our exam rooms. And to compete on joy, we have to dedicate ourselves to the art of making tails wag, cat's purr and have pet owners emotionally tethered to us.
Trust me, it is an art.
Here are a couple of little tricks to the art. Have in the record -- or ask the owner – what is the pet's favorite place to be petted or scratched. Find out a trick they know, ask the pet to perform it, then reward them for doing it. Have the exam room spritzed with pheromones and come armed with a veritable smorgasbord of tasty treats to tempt even the most anxious.
To compete on this level you – and your team – have to dedicate yourselves to knowing a unique and intimate detail of every pet who comes through the door. This can boil down to a single, simple question: Find out the genesis of the pet's name. I guarantee when you do this, you will commit that name to memory and you will have a life-long client. Heck, you will probably know something personal about this person that their best friends don't know. That is powerful.
I've preached the gospel of the tip-of-the-nose to the tip-of-the-tail exam because I think it is absolutely critical medically but it is also critical socially. It is, in so many cases, THE most tangible value we give our clients. And too often we do it in silence, like a CSI detective secretly sniffing around for evidence. We leave the worried client completely out in the cold while we do our thing. Instead we've got to keep them engaged.
The way to do that, again, is really simple and you've known it all along, even if you haven't acted on it. Talk your way through the exam. Tell the client exactly what you are doing, and why. Explain, explain, explain which means engage, engage, engage.
The client wonders why I'm sniffing inside their dog's ears. That's pretty natural. It looks a little weird, doesn't it? But if you tell them you can smell yeast in a dog's ears when you walk into the room – all you have to figure out is which one – they look at you like a god. When you tell them you can smell it the same way you smell popcorn in a movie theater, they know they brought their loved one to the right place.
Tell them that you see saliva stains that would indicate the dog's been licking its feet a lot and that's why you are paying particular attention between the dog's toes or on the bottom of his feet for the redness that often indicates yeast or staph infection. And, for goodness sake, tell them why you are looking in their dog's mouth and what it means to their health and longevity when that mouth is on fire.
You are exponentially increasing the value of what you are giving them for their dollar. You are not just a doctor in these moments; you've become a teacher. You've turned the exam into Dog or Cat Health 101. But not just a lecture, almost an equal part sermon. You are giving them the power to understand, which is another value they can't get from the Internet and the power to connect emotionally. Your power becomes their power.
Guess what, in that moment you can offer something the Internet cannot offer. As you examine the bottom of their dog's feet, they can ask you a question… a very personal question that may have to do specifically with how they live – maybe something about their dog they've been reluctant to mention – and you can answer them in real time.
Real time. What a concept.
What about that lone L? It stands for luminosity. Photographers talk about luminosity – it's one of their favorite phrases. What they mean by luminosity is not something technical, something about shutter speeds and pixels. They mean a certain quality some images have and others don't. They talk in terms of an image possessing “an inner light.” To the viewer's eye some pictures just seems to be lit from within. They glow.
So, here's an idea. Be a camera in your practice. Take a mental picture of it, then make that picture fit the vision you've always had for it. Harness the power and let it light your picture from within.
That's what these C's are about. They're about “the power” you have and how you can turn it on.
Be compassionate, and show it
Have clarity with who you are and what you're about.
Connect with your clients static-free
Communicate one-on-one in terms they can understand…and, more importantly, feel
Be competent and show it
Have the courage to compete
And be luminous – let your light shine.
We've taken a barrel roll off of the daily hamster wheel of activity that defines most veterinary practices, albeit momentarily, and hopefully have the “inspiration for the perspiration” that will turn to calluses on our hands an extra beat of our hearts and give us “the power” to make our practices c-worthy as we continually trumpet the message “Healthy pets visit vets!”